MEDICARE: KATHLEEN M. DWYER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932644226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M. DWYER

Provider Business Mailing Address
First Line	:	708 PARK AVE
Second Line	:
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021-3132
Country	:	US
Telephone Number	:	856-296-8794
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 PARK AVE
Second Line	:
City	:	LAUREL SPRINGS
State	:	NJ
Zip	:	08021-3132
Country	:	US
Telephone Number	:	856-296-8794
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	12/22/2016

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